Again, I think this post is missing nuance; for example:
Induction of fetal demise is done through a variety of means in multiple respects—different medications are given (i.e., digoxin, lidocaine, or KCl) via different routes (i.e., intra-fetal vs. intra-amniotic). (Given that lidocaine is a painkiller, I could see a different version of this post compellingly making the case that to the extent clinicians have discretion in choosing what agents to use to induce fetal demise, they should prioritize using ones that are likely to have off-target analgesic effects.)
So, the link you post refers to a small minority of abortions, as it’s only routine to inject the amniotic fluid (specifically) with potassium chloride (specifically) prior to the delivery of anesthesia in some second-trimester abortions.
Potassium chloride is a medication that’s routinely given via IV to replete potassium. The dose has a significant effect on how painful this is, as does the route of administration; people tolerate oral potassium fine. Importantly, the fetus is not even being given KCl intravenously (vs. intra-amniotically or intra-fetally), so it’s hard for me to infer from “it is sometimes painful to get KCl via IV” that it would be painful for a fetus to get potassium via a different route. Correspondingly, then, I don’t think the “inflames the potassium ions in the sensory nerve fibers, literally burning up the veins as it travels to the heart” applies.
I agree that clinicians should use lidocaine or digoxin over potassium chloride (KCL) for the reason you gave.
I wrote that the injection is “often of potassium chloride”, not always.
Given that the fetus is receiving a lethal dose of potassium chloride, I don’t think adults tolerating a much smaller medicinal dose should tell us much about how painful a lethal dose would be?
I agree that the fetus isn’t being given potassium chloride intravenously, although I didn’t know that when I wrote the post (another commenter pointed it out). I’ll add a line in the post disclaiming that comparison.
It is common ground in the lethal-injection context that the administered fatal dose of KCl would be excruciatingly painful without proper anesthesia (although that is in an IV context). I don’t know what dose is being used in abortions, but the lethal-injection dose is 100 to 240 mEq at once. I was given 15 mEq per hour in the hospital last month, although it can be done somewhat more quickly if there is an acute need. So I agree that adult toleration of a very gradual dose isn’t helpful evidence here.
Again, I think this post is missing nuance; for example:
Induction of fetal demise is done through a variety of means in multiple respects—different medications are given (i.e., digoxin, lidocaine, or KCl) via different routes (i.e., intra-fetal vs. intra-amniotic). (Given that lidocaine is a painkiller, I could see a different version of this post compellingly making the case that to the extent clinicians have discretion in choosing what agents to use to induce fetal demise, they should prioritize using ones that are likely to have off-target analgesic effects.)
So, the link you post refers to a small minority of abortions, as it’s only routine to inject the amniotic fluid (specifically) with potassium chloride (specifically) prior to the delivery of anesthesia in some second-trimester abortions.
Potassium chloride is a medication that’s routinely given via IV to replete potassium. The dose has a significant effect on how painful this is, as does the route of administration; people tolerate oral potassium fine. Importantly, the fetus is not even being given KCl intravenously (vs. intra-amniotically or intra-fetally), so it’s hard for me to infer from “it is sometimes painful to get KCl via IV” that it would be painful for a fetus to get potassium via a different route. Correspondingly, then, I don’t think the “inflames the potassium ions in the sensory nerve fibers, literally burning up the veins as it travels to the heart” applies.
I agree that clinicians should use lidocaine or digoxin over potassium chloride (KCL) for the reason you gave.
I wrote that the injection is “often of potassium chloride”, not always.
Given that the fetus is receiving a lethal dose of potassium chloride, I don’t think adults tolerating a much smaller medicinal dose should tell us much about how painful a lethal dose would be?
I agree that the fetus isn’t being given potassium chloride intravenously, although I didn’t know that when I wrote the post (another commenter pointed it out). I’ll add a line in the post disclaiming that comparison.
It is common ground in the lethal-injection context that the administered fatal dose of KCl would be excruciatingly painful without proper anesthesia (although that is in an IV context). I don’t know what dose is being used in abortions, but the lethal-injection dose is 100 to 240 mEq at once. I was given 15 mEq per hour in the hospital last month, although it can be done somewhat more quickly if there is an acute need. So I agree that adult toleration of a very gradual dose isn’t helpful evidence here.